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It’s no secret that Texas Gov. Rick Perry openly opposes federal health care reform. He has used every opportunity to reiterate that he will veto any effort by the legislature to participate in Medicaid expansion in Texas – an option granted to the states by last summer’s Supreme Court ruling. One source counts 14 states that have fully rejected accepting federal funds to extend health care coverage to low-income adults, while 20 states are fully participating in the expansion and 16 are undecided.

A state certain to participate in the expansion is Colorado, my new home state. The bill to expand Medicaid to 330,000 Coloradans passed both chambers of the General Assembly last week. Once the Senate approves amendments to the House version of the bill, it will head to the desk of Gov. John Hickenlooper, who has pledged to sign it into law.

In many respects (to the delight of this Texas native), the two states are very similar. Colorado has its urban capital, several other mid-size cities, and vast expanses of rural space. Residents also have a fierce loyalty to the state. And, until the past decade when control of the House, Senate, and the governor’s mansion has flip-flopped between the parties, Colorado has historically been conservative. The current split in the House is 37 Democrats, 28 Republicans. In the Senate, it’s 20 Democrats, 15 Republicans. And, of course, the governor is a Democrat.

By Troy Fiesinger, M.D.TAFP President, 2012-2013

When we walked into the dentist’s office, my kids ran straight up to the computer to check in for their appointments. This was my first time to take them to the dentist, as my wife usually drives them. My son and daughter quickly entered their names on the touch screen, grabbed books, and took their seats. Freed from manually registering patients, the front-desk clerk monitored patient flow and welcomed everyone to the clinic with freshly-baked chocolate chip cookies.

Later that day, I went to my doctor’s office where I signed my name on a clipboard and patiently waited in the lobby as patients have done for decades. His office has the same electronic medical record as mine, but his clipboard system has not changed in decades. My clinic has an electronic medical record with a web portal and secure patient e-mail, but our patients still queue at the front desk to give their information to a clerk. At the gas station, I swipe my credit card and fill my gas tank without talking to another human being. At the airport, I walk up to the kiosk, insert a credit card, and print the boarding pass for the flight I checked in to the night before. We expect businesses to adopt the latest customer service technology and embrace their use while we keep our clinics in the technological dark ages, suspiciously questioning each new innovation. We complain about the inefficiencies of our EMRs but are slow to adopt innovations to improve the efficiency and ease of our patients’ visits to our offices. Are we so focused on our frustrations that we forget our patients?

As I look with uncertainty to the future health care landscape and talk with fellow family physicians, I find many of us fearful of what the upcoming years will bring. I admit there are times when I get discouraged too, when it seems like things are too difficult to fix or that the problems are too big to solve. It’s in those moments that I realize we are living in a fallen world and the temptation is strong to just hide or give up. But God does not call us to hide our worries; he calls us to shine our light to the world around us. So I ask you, what does your light look like?

We are all called to be leaders to some degree, either in our families, our practice, or our government. Some will move on to state and national leadership realms, but it is okay if not all of us do that. How do you use your gifts and talents? Are you befuddled with frustration and worry? Have you hunkered down in seclusion? To squander our gifts and talents is like burying the best of ourselves in the sand. We’ll look back and wonder where the “good old days” have gone and realize that our health care system is no longer recognizable to us and that we have been left behind, frustrated and broken. Each of us has gifts and talents that should not be left unused.

AAFP recently submitted a letter to the Centers for Medicare and Medicaid Services urging them to create a new set of evaluation and management codes for primary care physicians. The recommendation, sent to CMS Acting Principal Deputy Administrator Jonathan Blum, was accompanied by supporting documents based on the research of TAFP member David Katerndahl, M.D., M.A.

The Academy suggested that CMS create the codes and include them in the 2014 Medicare physician fee schedule. AAFP Board Chair Glen Stream, M.D., said in the letter that a new payment model is necessary for the country to reach better health care for people and populations, as well as lower health care costs. “That system should recognize the complexity of ambulatory care provided by primary care physicians and reward the quality of services provided in their practices,” said Stream.

New E/M codes that differentiate primary care physicians from specialists or subspecialists would show the true value of both types of care, rather than devalue them as the current coding system does. Katerndahl’s research shows that the complexity of a primary care physician’s patient visit including E/M is much different than those with other specialists.

Recent Posts

By Jonathan Nelson

In yet another week of important committee meetings at the State Capitol, two family physicians provided testimony on some of TAFP’s top legislative priorities for the 86th Texas Legislature. On Monday, February 11, the House Appropriations Subcommittee on Article II convened to hear testimony from agencies and the public. Article II of the state budget contains funding for all agencies and programs that fall under Texas Health and Human Services, including Medicaid, CHIP, Healthy Texas Women, the Family Planning Program, services for the aging and those with disabilities, and much more.

TMA President and former TAFP President Doug Curran, MD, of Athens, told the committee that while Texas is indeed booming with a strong economy and lots of opportunity, many of the state’s health care statistics rank well below the national average.

By Jonathan Nelson

The Texas Legislature approached full stride this week as some of its most powerful committees began hearing testimony from state agencies and the public. The Senate Finance Committee took up Article II of the state budget, which contains funding for all agencies and programs that fall under Texas Health and Human Services. That includes Medicaid, CHIP, Healthy Texas Women, the Family Planning Program, services for the aging and those with disabilities, and much more. At roughly $80 billion for the biennium, Article II accounts for more than a third of total state expenditures.

Antonio Falcon, MD, of Rio Grande City, was the first TAFP member to address the committee on Wednesday morning, February 6, advocating for one of organized medicine’s top legislative priorities, the allocation of funding to ensure competitive and appropriate Medicaid payments. Those payment rates have not been increased in a meaningful or enduring manner in nearly two decades. Yet physician practice costs have increased by about 3 percent each year.

By Jonathan Nelson

We’re well into the third week of the Texas Legislature and now that the opening ceremonies are out of the way, lawmakers are beginning to get down to business. Both the House and the Senate have released their proposed budgets for the coming biennium, and both have announced committee assignments. Now the real work begins.

This session TAFP aims to fight for the restoration of funding for our family medicine residency programs to help address the increasing shortage of primary care physicians practicing in the state.

By Jonathan Nelson

We’re well into the third week of the Texas Legislature and now that the opening ceremonies are out of the way, lawmakers are beginning to get down to business. Both the House and the Senate have released their proposed budgets for the coming biennium, and both have announced committee assignments. Now the real work begins.

This session TAFP aims to fight for the restoration of funding for our family medicine residency programs to help address the increasing shortage of primary care physicians practicing in the state.